Categories of hospital and nursing home beds are expanding, under the advances of medical technology and, more importantly, the cost-cutting pressures from insurance companies and managed-care groups. More categories or layers of care-level can save money by providing patients with adequate care, but not more than required.
While "acute care" is the now lowest category of bed assigned to hospitals, "sub-acute care" and "post-acute care" may soon become new categories of competition for patients between hospitals and nursing homes. These beds offer lower levels of technology and personnel for recovering hospital patients who are still too sick to go home but who do not need the higher-cost acute care services.
The Maryland Health Resources Planning Commission is studying the need for these less-intensive levels of care and ways to categorize them. It has set aside 175 sub-acute beds -- previously reserved for nursing homes -- to be assigned to hospitals in the state as part of the project.
So far, it's been like a land office in the gold rush. Over three-quarters of the state's hospitals have already sent letters of intent to the commission, asking for nearly six times the 175 beds available. Final applications are due June 15.
The average length of stay in a hospital is declining, so hospitals have too many extra beds. They want to use these empty beds for less-intensive care, seeing a profitable market. But state agencies set rates and license the number and care-level of beds these institutions can operate. The planning commission wants to see if the hospitals will provide sub-acute care for a different type of patient than nursing homes now do.
The commission will parcel out these beds by region. The 17 Central Maryland hospitals have applied for 405 beds; only two institutions will get approval. But applicants see this as a chance to get a foot in the door for this promising health service.
Letters of intent filed with the HRPC by hospitals indicate a wide range of start-up costs and time frames, with a size of about 20 to 30 beds. All predict a multi-million-dollar revenue stream in the first year, even though charges are expected to be 30 to 50 percent lower than an acute-care bed.
Some hospitals that do not win the commission lottery will apply for approval of sub-acute beds under the regular HRPC review process. Hospitals that have already gotten into the home health care services view them as the next link in their health care continuum. But the commission must continue to guard against costly over-expansion of these facilities in this new wave of hospital enthusiasm.